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Case Reports
. 2011:2011:503758.
doi: 10.1155/2011/503758. Epub 2011 Oct 5.

Intravenous thrombolysis in ischemic stroke patients with intracranial neoplasms: two cases and a literature review

William Neil  1 , Bruce Ovbiagele
Affiliations
Case Reports

Intravenous thrombolysis in ischemic stroke patients with intracranial neoplasms: two cases and a literature review

William Neil et al. Case Rep Med. 2011.

Abstract

Based on exclusion criteria in the landmark NINDS-rtPA trial, current expert consensus guidelines preclude the use of intravenous recombinant tissue plasminogen activator (IV rtPA) in acute ischemic stroke (AIS) patients with intracranial neoplasm. There are only 3 published cases of administration of IV rtPA to AIS patients with intracranial neoplasms in the literature. Two of these published cases involved malignant brain parenchymal lesions discovered only after rtPA was inadvertently given, and one of these cases was associated with hemorrhage within the tumor. In this paper, we report two cases of administration of IV rtPA in AIS patients with intracranial neoplasms observed on neuroimaging prior to IV rtPA administration. In both cases, the tumor was outside of the brain parenchyma. The first case was an acoustic schwannoma and the second a falcine meningioma. Neither case was associated with intratumoral hemorrhage as of at least one week following IV rtPA treatment. More published cases are definitely warranted, but our experience with these two cases suggests that administration of IV rtPA to AIS patients in the presence of extraparenchymal brain tumors may not necessarily precipitate intra-tumoral bleeding and thereby worsen clinical outcomes.

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Figures

Figure 1
Figure 1
(a) Non-contrast head CT showing a heterogeneous lobulated mass within the left cerebellopontine angle (arrow). (b) Followup brain MRI in same patient 3 days later.
Figure 2
Figure 2
(a) Initial head CT showing parafalcine mass (arrow). (b) Head CT 36 hours after t-PA.
See this image and copyright information in PMC

References

    1. Albers GW, Olivot JM. Intravenous alteplase for ischaemic stroke. The Lancet. 2007;369(9558):249–250. - PubMed
    1. GENENTECH. Activase (Alteplase7056206) Package Insert Manufactured by LB0974 GENENTECH, INC. (4800512)
    1. Aleu A, Mellado P, Lichy C, Köhrmann M, Schellinger PD. Hemorrhagic complications after off-label thrombolysis for ischemic stroke. Stroke. 2007;38(2):417–422. - PubMed
    1. Adams HP, Jr., del Zoppo G, Alberts MJ, et al. Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Circulation. 2007;115(20):e478–e534. - PubMed
    1. Garcia AM, Egido JA, Garcia ME, Simal P. Thrombolysis for ischaemic stroke and glioblastoma multiforme: a case report. BMJ Case Reports. 2009;2009 - PMC - PubMed

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